Rheumatology and Immunology Therapy

2008 Pages·2004·86.14 MB·English

Blackplate(1,1)
A
A beta binations is strongly influenced by ethni-
city. In addition to expression on erythro-
cytes, AB blood group antigens are ex-
Beta-amyloid protein pressed on a variety of other cells, includ-
3
ing lymphocytes and platelets. Patients
with erythrocytes which express type A
antigen on their surface have serum anti-
A beta 2m
bodies against type B red cells, and vice-
versa. Patients with type O blood have
Amyloidosis, beta -microglobulin antibodies against both A and B antigens,
3 2
andpatientswithtypeABbloodhaveanti-
bodies against neither.
If, in accidental transfusion, type A blood
AA
isinjectedintopersonswithtypeBblood,
theinfusedredcellswillberapidlyhemo-
Arachidonic acid lyzed by antibodies in the recipients’
3
serum and will cause a severe transfusion
reaction which can be life threatening.
Likewise, type B red cells are destroyed
AA metabolites
by anti-B antibodies in type A blood.
TypeObloodcanbetransfusedinpersons
with type A, B, or O blood (and thus pa-
Arachidonic acid metabolites
3
tients with type O blood are considered
"universal donors") unless there is incom-
patibilitywithrespecttosomeotherblood
ABO blood group system
groupsystem.PersonswithtypeABblood
canreceivetypeA,B,orOblood(andare
Definition thus "universal recipients"). The ABO
antigens are developed before birth and
TheABObloodgroupsystemisamethod
remain throughout life.
of classifying human blood based on cell
surface antigens.
References
Full Text
1. Reid MR, Lomas-Francis C (1997) The
TheABObloodgroupsaredefinedbythe
blood group antigen facts book. Academic
presence of the type of surface sugar, Press, NewYork
whichdeterminesimmunogenicity.There-
lative distribution of the blood type com-
Blackplate(2,1)
2 ABObloodgroupsystem,transfusionreactions
ABO blood group system, fusion. Anaphylactic transfusion reactions
transfusion reactions arecharacterizedbytherapidonsetofana-
phylaxis(shock,hypotension,angioedema
and respiratory distress) following a trans-
Synonyms fusion containing plasma. These reactions
Immunologic blood tranfusion reactions. usually occur in people who are IgA defi-
cient who exhibit the presence of class-
Definition specific IgG, anti-IgA antibodies. Urticar-
ial transfusion reactions are due to the in-
There are several types of transfusion re-
teraction of allergenic substances in the
actions which include febrile nonhemoly-
plasma of donor blood products with pre-
tic, acute hemolytic, delayed hemolytic,
formed recipient IgE antibodies. This will
anaphylactic and urticarial. These occur
resultinthereleaseofhistaminefrommast
in 1–6% of all blood transfusions and are
cells or basophils, causing urticaria.
morecommoninpatientswithpre-existing
oncologic or hematologic disorders. Fe-
brile nonhemolytic transfusion reactions Differential Diagnosis
are the most common type of transfusion
Symptoms characteristic of the various
reaction and are believed to be caused by
transfusion reactions including anaphylax-
cytokines (i.e. IL-1, IL-8 and TNF-α).
is,angioedema,shock,urticaria,hemolytic
These cytokines are present in stored
anemiaandDICmaybefromothercauses
blood products and increase over time.
and should be thouroughly investigated.
Also possible is an interaction between
Additional problems to consider include
donor leukocytes and recipient antibodies
food allergies, cardiogenic pulmonary
which might cause the release of IL-1, re-
edema,sepsisandcoldagglutininimmune
sulting in a fever during the transfusion.
hemolysis.
These transfusion reactions can also
occur after platelet transfusions and thus,
another proposed etiology involves the re- References
lease of platelet-derived CD154 (CD40 li-
1. Sazama K, DeChristopher PJ, Dodd R
gand), which is capable of producing (2000) Practice parameter for the recogni-
proinflammatory cytokines from fibro- tion, management, and prevention of ad-
blasts, epithelial cells, and endothelial verse consequences of blood transfusion.
cells. Acute hemolytic transfusion reac- College of American Pathologists. Arch
Pathol LabMed124(1):61–70
tions occur when the donor red blood
2. Silvergleid AJ (2003) Immunologic Blood
cellsaredestroyedbythepreformedrecip-
TransfusionReactions.http://www.uptodate.
ientantibodies.Thesereactionsareusually
com
due to ABO incompatibility (group O re-
cipient is given non-group O red blood
cells), usually due to clerical error, but
may also result from acquired alloantibo-
Abortion, anticardiolipin
dies (i.e. anti-Rh, anti-Jka).
antibody
Delayed hemolytic transfusion reactions
result from re-exposure to foreign red
blood cell antigens causing an antibody
Synonyms
response. These reactions may occur fol-
lowing exposure during previous organ Pregnancy loss, fetal loss, antiphospholi-
transplantation, pregnancy or blood trans- pid syndrome, APS.
Blackplate(3,1)
Acanthosisnigricans 3
Definition A
shown to providebenefit inpreventingre-
Pregnancy loss associated with anticardio- current miscarriages.
lipin antibodies.
References
Full Text
1. Branch DW, Porter TF, Paidas MJ, Belfort
Pregnancy loss is associated with the pre- MA, Gonik B (2001) Obstetric uses of
senceofmaternalantiphospholipidantibo- intravenous immunoglobulin: successes,
failures, and promises. J Allergy Clin
dies (anticardiolipin antibodies and lupus
Immunol 108:S133–8
anticoagulants). The type of pregnancy
2. Scott JR (2003) Immunotherapy for recur-
loss most frequently associated with anti-
rent miscarriage. Cochrane Database Syst
phospholipidantibodiesistheunexplained RevCD000112
deathofamorphologicallynormalfetusat
or beyond 10 weeks gestation. Spontane-
ousabortionsbefore10weeksmayalsobe
Acanthosis nigricans
associated with antiphospholipid antibo-
dies. Fetal death associated with antipho-
spholipid antibodies is most likely due to Synonyms
insufficient uteroplacental blood flow and Keratosis nigricans.
fetal hypoxia.
Definition
References
Accompanies obesity, diabetes mellitus,
1. Branch DW, Khamashta MA (2003) Anti-
excess corticosteroids, genetic mutations,
phospholipidsyndrome:obstetricdiagnosis,
evironmental factors nicotinic acid, estro-
management,andcontroversies.ObstetGy-
necol 101:1333–44 gens, corticosteroid, tumors: adenocarci-
noma, pineal tumors, amongst other pa-
thology. A brown thickening of skin
which may progress to a leathery, warty
Abortion, intravenous
or papillomatous appearance do to papil-
immunoglobulin
lary hypertrophy, hyperkeratosis, and in-
creased epidermal melanocytes. Most
Synonyms common sites are the axillae and flexural
Pregnancy loss, fetal loss, IVIG.
Definition
Use of intravenous immunoglobulin
(IVIG) to prevent pregnancy loss due to
immunological abnormalities.
Full Text
Intravenous immunoglobulin has been
used in an attempt to prevent pregnancy
loss in women with the antiphospholipid
syndrome and unexplained recurrent mis-
carriages. In the antiphospholipid syn-
drome, IVIG was no more effective than Acanthosis nigricans.
heparin and low-dose aspirin. In rando- Figure1 Acanthosis nigricansona16
mized controlled trials IVIG has not been year-oldgirl(courtesyofSateHamzaMD).
Blackplate(4,1)
4 Acarbose
surfaces of the neck, groin, belt line, dor- type II diabetes mellitus. A study of 1429
sumofthefingers,mouth,periareolaeand subjects with impaired glucose tolerance
umbilicus. randomized to either acarbose or placebo
foundthatacarbosesignificantlydecreased
Differential Diagnosis the risk of progression to diabetes and re-
Benign/pseudoacanthosis nigricans – versedglucoseintolerancemorefrequently
mostlyontheobesespeculatedtocorrelate thanplacebo.Acarbosemayhavearolein
with increased fasting plasma insulin le- the prevention of diabetes in some at-risk
vels. Sometimes benign disease relates to patients.
rare autosomal dominant trait without un-
Dosage
derlying endocrinopathy. May sometimes
be drug induced. Rangesfrom50mgto100mgtakenthree
times daily, taken with the start of each
References meal.
1. Habif T (1996) Clinical Dermatology, 3rd
Contraindications
ed.MD Consult
Acarbose may cause gastrointestinal dis-
tress including flatulence, cramping and
diarrhea due to the presence of undigested
Acarbose
carbohydratesinthebowel.Therefore,pa-
tients with colonic obstruction or inflam-
Trade Names
matory boweldisease,orpatients prone to
Precose (US), Glucobay, Gluconase, Glu- developing intestinal obstructions, should
mida, Precose, Prandase. not take this drug. Elevated hepatic trasa-
minases have also been observed with
Class and Category acarbose use so patients with cirrhosis
Alphaglucosidaseinhibitor,anti-hypergly- should avoid the drug. Patients with dia-
cemic agent. betic ketoacidosis should not be adminis-
tered acarbose.
Indications
Adverse Reactions
The primary use of acarbose is the man-
agementofhyperglycemiainpatientswith The most common adverse reactions are
GI symptoms related to undigested carbo-
hydrates traversing the gut. Higher doses
ofacarbosehavebeenassociatedwithele-
vated hepatic transaminases and occasion-
allyhyperbilirubinemiaandjaundice.Rare
casesoffulminanthepaticfailurehavenot
been shown to be clearly related to acar-
bose use.
Drug Interactions
Drugsthatimpairthemechanismofaction
ofacarboseorinterferewiththeinteraction
of acarbose with the gut epithelium could
reduce the effectiveness of the drug.
Acanthosis nigricans.
Therefore,intestinalanti-absorptiveagents
Figure2 Acanthosis nigricansaxilla.
Blackplate(5,1)
Acetaminophen 5
(i. e. charcoal) and replacement pancreatic Accessory cells A
enzymes (pancreatin, amylase) should not
be taken. Withdrawal of hyperglycemic
Definition
agents such as cortcosteroids in patients
Nonlymphoid cells which are required to
takingacarbosecouldprecipitatehypogly-
induce a T-cell dependent immune re-
cemia, so blood glucose should be moni-
sponse.
tored closely in these situations.
Full Text
Mechanism of Action Accessory cells are nonlymphoid cells
such as macrophages, dendritic cells, and
Acarbose is a complex oligosaccharide
Langerhanscells(epithelialdendriticcells)
thatcompetitivelyinhibitsgutenzymesre-
that function to present antigens to MHC-
sponsible for metabolizing complex
restrictedTcells.Theyarenotantigenspe-
starches and oligosaccharides into absorb-
cific and they present different costimula-
ableglucose.Asaresult,theabsorptionof
torymolecules,eithersolublecytokinesor
ingested carbohydrates is delayed and
memebrane bound peptides, with the anti-
post-prandial hyperglycemia is reduced.
gen to the T-cells. The specific combina-
Acarboseinhibitsthefunctionofpancreat-
ic α-amylase in the intestinal lumen and tionofantigen,MHC-restrictedTcell,and
intestinal membrane-bound α-glucosidase expressed costimulatory molecules deter-
mines the specific immune response.
hydrolase enzymes.
References
Definition 1. Yung RL (2000) Geriatric rheumatology,
changes in immune function with age.
Acarbose is a unique anti-hyperglycemic
RheumDisClin North Am26:455–73
agent which reduces post-prandial hyper-
glycemia by inhibiting intestinal enzymat-
icactivityresponsibleformetabolizingin-
ACE
gested carbohydrates into absorbable
sugar. Since it has a unique mechanism
of action, acarbose can be used in combi-
Angiotensin Converting Enzyme
nation therapy with other medications to 3
treattypeIIdiabetes,includingsulfonylur-
eas and metformin.
Acetaminophen
References
Synonyms
1. (2002)Acarbose.In:NissenD(ed)Mosby’s
Paracetamol.
Drug Consult13thed.Mosby,St.Louis
2. Chiasson JL, Josse RG, Gomis R, et al
Trade Names
(2002) Acarbose for prevention of type 2
diabetes mellitus: the STOP-NIDDM ran- Tylenol.
domised trial. Lancet359:2072–7
3. Mertes G (2001) Safety and efficacy of Class and Category
acarboseinthetreatmentofType2diabetes:
Analgesic; antipyretic.
data from a 5-year surveillance study. Dia-
betes ResClin Pract52:193–204
Indications
Arthralgia; dental pain; dysmenorrhea;
Blackplate(6,1)
6 Acetylcholinereceptorantibodies
fever; headache; mild pain; myalgia; os- alone or in combination with other medi-
teoarthritis. cations for the treatment of pain, fever,
sinus symptoms, and the symptoms of
Dosage upper respiratory infections. Acetamino-
Adults and children age 12: 325–650 mg phen is available over the counter and by
orally or per rectum every 4–6 hours as prescription.
needed; or 1000 mg orally or per rectum
2–4 times per day. Maximum of 1000 mg References
per dose and 4000 mg per day. Children 1. RobertsLJ2nd,MorrowJD(2001)Analge-
andinfants:10–15mg/kgorallyorperrec- sic-antipyretic and antiinflammatory agents
tumevery4–6hours.Maximumof5doses and drugs employed in the treatment of
in24hours.Neonates:10–15mg/kgevery gout. In: Hardman JG, Limbird LE (eds)
6–8 hours. Pharmacological Basis of Therapeutics, 9th
ed.McGraw-Hill, NewYork,pp687–731
Contraindications
Relative contraindications: severe liver
Acetylcholine receptor
disease, alcoholism, and prior hypersensi-
tivity reactions to acetaminophen. antibodies
Adverse Reactions
Autoantibodies, myasthenia gravis
Hepatoxicity may occur after acute over- 3
dose, or with chronic excessive intake.
Acetaminophen in combination with
other analgesics may contribute to analge- Acetylsalicylic acid
sicnephropathy.Methemoglobinemiawith
acute overdose.
Aspirin
3
Drug Interactions
Diflunisal increases acetaminophen drug
levels. Regular ethanol consumption in- Achilles bursitis
creasesriskofacetaminophenhepatictox-
icity.
Synonyms
Mechanism of Action Retrocalcaneal bursitis, adventitial bursi-
Mechanism of action not completely tis, superficial calcaneal bursitis, pump
known. Inhibits cyclooxygenase in the bump.
central nervous system which may contri-
bute to analgesic and antipyretic proper- Definition
ties. Inflammationofeitherofthe2heelbursa.
One bursae (retrocalcaneal) lies between
Definition
the Achilles tendon and the calcaneus,
Acetaminophen isapara-aminophenolde- and the second bursae (superficial calca-
rivative with analgesic and antipyretic ac- neal) overlies the Achilles tendon. Often
tions; but no significant anti-inflammatory mistaken for Achilles tendonitis, although
activity.Acetaminophenisthedrugoffirst patients may have both (Haglund’s syn-
choice for treating pain and fever in chil- drome). Overuse injury and low cut
dren. In adults, acetaminophen is used shoes are predisposing risk factors.
Blackplate(7,1)
Achillestendonitis 7
Pharmacological Achilles tendonitis A
Non steroidal anti-inflammatory drugs
mayoftenbeusefultotreatpainassociated
Synonyms
with bursal inflammation and pain. Some
physicians perform glucocorticoid injec- Achilles tendinitis.
tionsintothebursa.However,directinject
into the Achilles tendon is generally not Definition
recommended as this procedure has been
Inflammation of the Achilles tendon. Eti-
associated with tendon rupture.
ology is usually mechanical, including in-
correct running technique, overuse, or
Non-pharmacological poorly fitting shoes. Other causes include
rheumatic conditions predisposing to ten-
Application of ice and/or heat is simple
donitis such as spondyloarthropathies.
and may be effective in reducing inflam-
mation. Ultrasound also can be used to
treat this condition. Shoe inserts placed at Therapy
the posterior heel or switching to shoes
Pharmacological
without heels (e.g. open backed sandals)
Non steroidal anti-inflammatory drugs
can also be helpful.
mayoftenbeusefultotreatpainassociated
with tendon inflammation and pain. Some
General Therapeutic Measures physicians perform glucocorticoid injec-
tions at the site of tendon inflammation,
Lifestyles
which may also be therapeutic. Caution
Rest and gentle stretching are often help-
must be taken not to directly inject into
ful.Itisalsoimportanttoavoidingexacer-
the tendon itself (often associated with a
bating activities, such as walking or run-
high degree of resistance), as this may in-
ning uphill.
crease the risk of tendon rupture.
Prognosis Non-pharmacological
Generallygood,andoftenthisconditionis Many physicians recommend application
self-limited. However, recurrence is com- of ice in the first 24–48 hours following
mon. Surgical resection of the bursa (and atendoninjury.Heatisoften usedfollow-
any associated bony prominence of the ingthattime,althoughnooptimalregimen
calcaneus) is rarely performed for refrac- forthesemodalitiesexist.Althoughrestor
tory cases. evenimmobilization(oftenwithasplintor
sling) of an anatomic structure may speed
recoveryifthetendoninflammationisdue
References
to an overuse injury, patients should con-
1. Mazzone MF, McCue T (2002) Common
tinue passive range of motion.
conditions of the achilles tendon. Am Fam
Physician 65(9):1805–10
General Therapeutic Measures
Lifestyles
Achilles tendinitis Rest and gentle stretching are often help-
ful.Itisalsoimportanttoavoidingexacer-
bating activities, such as walking or run-
Achilles tendonitis ning uphill.
3
Blackplate(8,1)
8 Achondroplasia
Prognosis 2. Ruddy S, et al (eds) (2001) Kelley’s Text
Generallygood,andoftenthisconditionis book of Rheumatology, 6th ed. WB Saun-
ders,Philadelphia
self-limited. However, recurrence is com-
3. Cecil RL, Bennett JC, Goldman L (eds)
mon.
(2000)CecilTextbookofMedicine,21sted.
WBSaunders,Philadelphia
References
4. Larson PR (2003) Williams Textbook of
1. Mazzone MF, McCue T (2002) Common Endocrinology, 10th ed. WB Saunders,
conditions of the achilles tendon. Am Fam Philadelphia
Physician 65(9):1805–10
Acid ceramidase deficiency
Achondroplasia
Definition 3Faber’s disease
Most common chondrodysplasias in hu-
mans. Autosomal dominant trait (fibro-
blast growth factor receptor-3 gene local- Acid maltase deficiency
ized to 4p16.3) with sporatic new muta-
tions observed in 80% increasing in fre-
Definition
quency with paternal age. Estimated fre-
quency of 1/14,000–40,000 live births. Enzyme deficiency of alpha glucosidase
Characterized by short-limbed (rhizome- found in lysosomes that catalyze glucose
lia), short trident hands, redundant skin, release from complex sugars. Located on
normal-sized trunk, waddling gait, thora- chromosome 7q21-23, alpha-glucosidase
columbargibbous(severekyphosis),meg- deficiency is thought to be transmitted as
alocephaly with frontal bossing, low nasal an autosomal recessive trait that affects
bridge. Radiographs: small cuboid-shaped three distinct age groups. Infant form,
vertebral bodies, progressive narrowing of Pompe’s disease, occurs between 0–2
the lumbar interpedicular distance, small yearsofagecausingweakness,hypotonia,
iliac wings, narrow sciatic notches. andCHFinvariablyleadingtodeath.Mas-
sive gloycogen deposits can be found in
Prognosis cardiac, hepatic, neural and muscular tis-
Homozygousinfantstypicallydieininfan- sue. Early childhood forms present with
cyfromrespiratoryinsufficiencysecondto muscle weakness, proximal > distal, with
asmallthoraxwhilemeanadultmalesand progressive respiratory failure leading to
females are 130 and 120 cm respectively. deathinthe30s.MaysimulateDuchenne’s
Despite problems achondroplasia does not muscular dystrophy with firm, rubbery
incur a shorter life expectancy nor poorer gastrocnemius and deltoid muscles, gas-
health. Complications arise from hydro- trocnemius hypertrophy and the Gowers’
cephalus, neuronal compression of such sign. Late toe walking develops after
systems as brain stem, spinal cord, or anklecontracturesandlumbarlordosiscre-
nerve roots via minimal impingement by ates an unsteady gait.
a disk or osteophyte is common. Adult onset, 30–40s, with muscle weak-
ness noted to be a progressive myopathy,
References onethirddeveloprespiratorycompromise.
1. Stedman’s Medical Dictionary. http://www. Proximalpelvicgirdleorthoraxicintercos-
stedmans.com tals and diaphragm muslces are mostly in-
Blackplate(9,1)
Acne 9
volved in a groupwise fasion although in- 4. Cotran RS, et al (eds) (1999) Robbins A
dividual muscle parts may be affected. Pathologic Basis of Disease, 6th ed. WB
Saunders,Philadelphia
Often adults are mislabeled as polymyosi-
5. Koopman WJ (ed) (2001) Arthritis and
tis or late-onset muscular dystrophy.
Allied Conditions. Williams & Wilkins,
Creatine phosphokinase is usually ele-
Baltimore
vated. Venous lactate concentrations in-
creasenormallyafterforearmischemicex-
ercise. EMG changes consistent with in-
ACL
tense electric irritability, myotonic dis-
charge without a clinical picture of myo-
tonia. Deficient or decreased alpha-gluco-
Anticardiolipin antibodies
3
sidase activity in muscle or leukocytes all
butdefinesthedisease.Biopsyshowsvac-
uolar myopathy with elevated glycogen
Acne
and acid phosphatase staining. Small foci
of acid phosphatase can be found in mus-
cle fibers without vacuoles. Electron mi- Synonyms
croscopyshowsglycogendepositioninin- Acne vulgaris.
volved muscle. Definitive diagnosis via
enzyme activity levels is needed. Definition
Acneisaskindiseaseofthepilosebaceous
Therapy
follicles.Hairfolliclesdevelopretentionof
Non-pharmacological
keratin and sebum, which leads to inflam-
Nocturnal respiratory support, with resis- mation and follicular plugging. This leads
tiverespiratorymuscleexercises,areoften toformationofpapules,comedones,cysts,
helpful. pustules, and nodules. Acne most com-
Severe early respiratory muscle failure re- monlyaffectsthefaceandtrunkofadoles-
sults in early bilevel positive airway pres- cents.Mostpatientsoutgrowacneafterad-
sure or continuous positive airway pres- olescence,howeversomepatientscontinue
sure dependency with possible long term to have symptoms in their twenties and
home ventilation required. thirties.Thereisastronggeneticpredispo-
sition in most patients. Stimulation of se-
General Therapeutic Measures
baceous glands by excessive androgens
Diet and metabolism of sebum by Proprioni-
High protein. bacterium acnes, forming free fatty acids,
may lead to development of acne.
Prognosis
Therapy
See above.
Pharmacological
References Topical therapy with benzoyl peroxide,
1. Ruddy S, et al (eds) (2001) Kelley’s Text topical retioids, and topical antibacterials
book of Rheumatology 6th ed. WB Saun- may reduce levels of Proprionibacterium
ders,Philadelphia acnes, and prevent new lesions from de-
2. Goetz CG (1999) Textbook of Clinical
veloping.
Neurology.WB Saunders,Philadelphia
Oral antibiotics, including tetracycline,
3. Noble J (ed) (2000) Textbook of Primary
CareMedicine,3rded.ElsevierScience,St. doxycycline, minocycline, clindamycin,
Louis and erthythromycin reduce the number of
Blackplate(10,1)
10 Acnearthritis
References
bacteriaontheskin,thuspreventingdevel-
opment of new lesions. Oral contracep- 1. Odom RB, James WD, Berger TG (eds)
tives and spironolactone act to inhibit (2000) Acne: Andrews’ Diseases of the
Skin. Clinical Dermatology, 9th ed. WB
ovarian androgen secretion, and thus de-
Saunders,Philadelphia, pp284–93
crease sebum production. However, oral
contraceptives which have androgenic
properties may worsen acne. Isotretinoin
Acne arthritis
is approved for treatment of severe cyctic
acne. This agent is highly teratogenic and
may cause hypertriglyceridemia, thus ex-
Arthritis, acne
treme precautions must be undertaken to 3
monitor for pregnany and elevated trigly-
cerides.
Acne conglobata
Non-pharmacological
Synonyms
Abrasive cleansers, astringents, and soaps
Nodulocystic acne.
are not typically helpful, and may in fact
lead to irritation and drying of the skin. Definition
Local surgical treatment may be used in
Acne conglobata is a severe form of acne
which a follicle is incised with a scalpel,
in which the lesions are inflammatory co-
and the contents of the leson are ex-
medones,papules,orpustules.Thelesions
pressed. Corticosteroids may be injected
are located on the face, forehead, and
in cysts, inflammatory papules and pus-
neck, and may communicate and form
tules; however atropy and hypopigmenta-
cysts and sinus tracts. The disease is
tion of the skin may result if the steroid is
most common in teenaged males. Acne
not diluted with sterile saline.
conglobata is often chronic, and may
lead to severe scarring. The follicular
triad syndrome includes acne conglobata,
General Therapeutic Measures
hidradrenitis suppurativa, and dissecting
cellulitis of the scalp. Musculoskeletal
Diet
symptoms similar to the features of sero-
Despite myths about foods exacerbating
negativespondyloarthropathiesmaybeas-
acne (e.g. greasy foods and chocolates),
sociated with this triad, including periph-
there is no data to support this.
eral arthritis and sacroilitis, often present-
ingconcurrentlywithaflareofskininvol-
vement.
Lifestyles
Patients are discouraged from manipulat- Therapy
ing lesions, as this may worsen scarring.
Pharmacological
Topical therapy using benzoyl peroxide
Prognosis may be utilized, however more aggressive
therapy is usually considered early to
The majority of patients will have resolu-
avoidscarring.Tetracycline,erythromycin,
tion of symptoms after adolescence. Early
or minocycline may be used as systemic
treatmentmay help prevent emotional dis-
therapy.Isotretinoin1–2mg/kd/dayispre-
tress and scarring.
scribed for five months’ duration. If the